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Unmet Healthcare Needs and Associated Factors in Rural Vietnam: a Cross-Sectional Study

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Unmet Healthcare Needs and Associated Factors in Rural Vietnam: a Cross-Sectional Study Unmet Healthcare Needs and Associated Factors in Rural Vietnam: A Cross-Sectional Study Ju Young Kim Seoul National University Bundang Hospital https://orcid.org/0000-0001-6018-3337 Ju Young Kim Seoul National University Bundang Hospital Dae In Kim Seoul National University Bundang Hospital Hwa Yeon Park Seoul National University Bundang Hospital Yuliya Pak Seoul National University Bundang Hospital Phap Hoang Ngoc Tran Ho Chi Minh City University of Medicine and Pharmacy Thai Thanh Truc Ho Chi Minh City University of Medicine and Pharmacy Mai Thi Thanh Thuy Ho Chi Minh City University of Medicine and Pharmacy Do Van Dung ( [email protected] ) https://orcid.org/0000-0001-6872-3481 Research Keywords: Health services accessibility, medically underserved area, healthcare disparities Posted Date: June 16th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-35473/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/19 Abstract Background: Although health status in Vietnam has been much improved, people living in rural areas have faced several challenges, including a rapid increase of the aging population, inadequate capacity of health system, and problems of inequities in access to the healthcare system. The purpose of this study was to examine the current utilization of healthcare services, exploring unmet healthcare needs and their associated factors among adults living in rural Vietnam. Methods: This cross sectional study was conducted with 233 participants in a rural area of Binh Phuoc province and a suburban area of Da Lat city in Vietnam from October–December 2017. The methods included face-to-face interviews using a structured questionnaire as well as anthropometric and blood pressure measurements. We considered participants to have unmet health needs if they had any kind of health problem during the past 12 months for which they were unable to see a healthcare provider in the same period. Multivariate logistic regression analysis was performed to determine the factors associated with unmet healthcare needs. Results: Of the participants, 18% (n=43) had unmet healthcare needs. The common causes of unmet healthcare were transportation (30%), a lack of available doctors or medicines (47%), and communication issues with healthcare providers (16%). The multivariate logistic regression showed that having stage 2 high blood pressure and reporting no place to go for medical problems were associated with unmet healthcare needs. Conclusions: Healthcare services are still needed in disadvantaged group living in rural or suburban area of Vietnam. Efforts should focus on availability of medicines, improvement of transportation system as well as communication skills of healthcare providers to improve access to healthcare services. Background Vietnam has made enormous progress not only in its socioeconomic development, but also in the overall health status of its citizens. Vietnam has achieved several health-related Millennium Development Goals, such as the decrease of infant and maternal mortality, increased immunization coverage of 97.2% for children younger than 1 year old, and increased treatment rate of 80% for tuberculosis and HIV/AIDS patients.(1) Life expectancy increased from 70.5 years in 1990 to 75.8 years in 2015. In addition, there has been rapid increase in public health facilities and medical equipment available due to increased funds for the health sector from both the government and private sources. (2) Still, there are several challenges for and problems in Vietnam’s healthcare system. These include an emerging increase of noncommunicable diseases (NCDs), such as cardiovascular disease, cancer, and diabetes, an aging population, an inadequate capacity of the health system, and inequities in access to the healthcare system. (2-4) Page 2/19 According to a study on NCD service availability in Vietnam that focuses on ethnic minorities living in a mountainous area, commune health centers play a main role in NCD care and risk factor management, but they have limited NCD preventive and treatment services, have limited medication availability, and are underutilized. (5) Unmet healthcare needs can be dened as the differences between the utilization of necessary healthcare services to manage a particular health problem and the actual medical service used. (6) (7) Unmet healthcare needs have been reported to be associated with a high mortality rate, especially in the elderly adults population. (8, 9) Unmet healthcare needs and health utilization indicators have also been used to monitor equity in health services.(10, 11) Factors associated with unmet needs for healthcare services depend on the healthcare system as well as individual status, but, in general, they can be classied into three categories. (12, 13) The rst category is accessibility, which includes distance to medical facilities, transportation, and nancial factors. The second is acceptability, which includes awareness and knowledge about health care. The third is availability, which includes the unavailability of certain medical services, delay, and medical services not being available in certain areas. The purpose of this study was to examine the current utilization of healthcare services by exploring unmet healthcare needs and their associated factors among adults living in rural Vietnam. Methods Study design and participant recruitment This study was done as a part of feasibility study in Korea’s ocial development assistance project, in collaboration with The University of Medicine and Pharmacy at Ho Chi Minh City. It was a cross sectional study conducted in one rural area in Binh Phuoc province, and the other one of suburban area, Da Lat city in Lam Dong province. These areas were selected due to cooperation from commune health centers and convenience of transportation for interviewers. Located in the Southeast region of Vietnam, Binh Phuoc, a predominantly rural province, covers an area of 6,871 km2, and is divided into 5 commune-level towns, 92 communes, and 14 urban communes. The population of Binh Phuoc in 2015 was 944,400. Dak Nhau, a commune in Binh Phuoc, is in a mountainous area and is 30 to 70 km away from the district hospital. Dak Nhau commune is the residence of ethnic minority peoples, especially the Stieng and Mnong people. Located in the central highlands of Vietnam, Da Lat city, a district level city, covers an area of 395 km2, spreading over 12 urban communes and 4 communes. The population of Da Lat in 2015 was 406,105, of which 55,596 were suburban inhabitants (13.7%). The suburban residents primarily make their money from agriculture, forestry, or handicrafts, and agriculture plays an important part of their local economy. The Ta Nung commune, Tram Hanh commune, and urban commune #7 were selected. These communes are all in suburban areas of Da Lat city, and are 7 to 30 km away from the district hospital. Page 3/19 We selected 203 participants in the Binh Phuoc province and 101 participants in Da Lat city from a list of households from the local authorities, and a total of 304 people were recruited for participation in this study. Among them, 233 people were nally selected after excluding participants less than 19 years old. Well-trained researchers from the faculty of public health of the University of Medicine and Pharmacy at Ho Chi Minh City visited households with help from local health facility leaders and invited family head or any other members of family at home to participate in the survey. Survey instrument and measurements Face-to-face interviews were conducted using a structured questionnaire, which included questions about the participant’s socio-economic status, health problems, health service utilization, health service responsiveness and satisfaction, and healthcare services needed. The socioeconomic characteristics included age, gender, marital status, education level, ethnicity, occupation, monthly income, number of family members, and health insurance. Health related factors included self-perceived health status, smoking, drinking, physical activity, and underlying chronic disease, such as hypertension, diabetes mellitus, dyslipidemia, heart disease, stroke, chronic lung disease, and depression. Anthropometric measurements including height, weight, and systolic and diastolic blood pressure (SBP and DBP, mmHg) were taken by the researchers using a portable weight and height measurement device (BSM370, InBody Co., Seoul, Korea) and a blood pressure measurement device (HEM-1020, Omron Co., Tokyo, Japan). Height and weight were measured with the subjects barefoot and lightly clothed. Blood pressure was measured twice and recorded when subjects were sitting. Body mass index was calculated as kg/m2. Blood pressure was chosen for the mean values of two measurements and categorized as normal (SBP <130 and DBP <85), prehypertension (130≤SBP <140 or 85≤DBP <90), stage 1 hypertension (130≤SBP <140 or 85≤DBP <90), or stage 2 hypertension (SBP ≥160 or DBP ≥100 ).(14) Questions regarding healthcare service utilization consisted of number of admissions to the hospital or visits to an emergency department and number of visits to an outpatient clinic during the previous 12 months, and expenses during those admissions or visits. Participants were also asked to evaluate healthcare services they had experienced, that is, how satised they were with the healthcare services, and were requested to suggest further improvements they needed. Participants were compensated with a cash equivalent
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